Cataract surgery: which type of lens do I want?July 19, 2010 12:46 PMSubscribe

I'm looking at cataract surgery in the next year or two, and wondering what my options are as far as lenses go.

YANMD, but I'm hoping some of you have made this decision and have experiences or impressions to share. The major decision is what kind of lens to get as a replacement - the tried-and-true single-focus lens? A multifocal lens? Or these new adaptive focus lenses that are supposed to respond to my eye muscles and change focus accordingly? I'll be seeing a cataract specialist soon, but my primary opthamologist was kind of vague on what the options and considerations were.

The two factors that stand out in particular, I think, are that I'm young (mid 20s), and my vision is good enough that I'm not already using bifocals, which I'd have to if I got a single-focus lens; and that only one eye's cataract is worth operating on right now, which I understand can make light from some types of lens difficult to integrate with my unaffected eye.

So, Mefites - have you had cataract surgery, and which lens did you pick? What surprised you, or turned out to be different than you expected? What do you wish you'd known going in?

The surgeon inserted the IOL at the right distance to give me 20/20 vision in that eye. A couple of my current eye geeks believe that he ought to have maintained it at my original -7.75 diopters instead. High myopia and major trauma to the eye mean you have to play things a little conservatively, and my current specialists are more conservative in some regards than my old doctor was. (Everyone's different-- my surgeon thought it would work, gave me the option, and I consented. I don't have any issue with him, he's a smart guy and he saved my eye when other doctors were recommending globectomy.)

20/20 vision was pretty freaking awesome until it abruptly wasn't-- I suffered a retinal detachment two years later. This happens. It happens to a very small percentage of patients-- and remember, I was a high myope with trauma, my odds were probably higher than average-- but it is a risk. A very smart and experienced surgeon performed a cryopexy and scleral buckling to fix it; you can Google that, but be warned that the scleral buckling operation is both really painful and really upsetting to watch. It's likely not worth freaking yourself out about

(The *cataract* operation itself is a cakewalk. It shouldn't take more than 5 minutes and then you'll go home, grab a nap, get up, and get a bite to eat. Mine took 12 because, again, there was epic crazy shit going on in there-- and the nurses considered 12 minutes to be an insanely long time and clucked and fussed over me a whole bunch.)

As a result of the detach, I have permanent retinal scarring. My vision in that eye is somewhere between -3.00 and -4.00 uncorrected. Glasses will not fix a lot of the problem in there, but they do help. I occasionally have to position things I'm looking at so that they don't intersect my retinal scar.

I had two followup laser procedures called capsulotomies in 2006 to remove the last vestiges of the capsule, or the bag of tissue that held the natural lens in place. The capsule will cloud over once it's been opened and the IOL inserted; that's normal, and it will take a long-ass time to do so enough to warrant the laser.

A capsulotomy sounds awful, but it's pretty laid-back; you sit on the receiving end of the laser with your head in one of those chin-rest periscope-type exam tables, and they zap the capsular material with a red laser. It will make weird popping sensations in your head due to pressure changes; this is harmless, just weird. You're wide awake for it and they monitor you carefully, take breaks, etc. Doesn't take very long.

Capsulotomies cause floaters, which eventually settle out of your vision-- if you're already paranoid about floaters from, say, having had a retinal detachment, you'll need to ramp down the paranoia for a while after getting the laser.

Really, I know I sound terribly dour, but I'm confident that almost no one will have the experience I had. I am the sort of eye patient where the attending brings the residents in and quizzes them while they look at me. My old surgeon was writing a paper about injuries like mine.

You're gonna be OK, it's gonna be short, you're going to be somewhat awake but completely doped out of your mind on Versed or something similar, and you're going to love it when they take the patch off the next day. Do your drops religiously both before and after, and call the doc if *anything* seems unusual to you.posted by fairytale of los angeles at 1:54 PM on July 19, 2010 [1 favorite]

I am 42 and had to have cataract surgery in feb after recovery of my sight in one eye after bilateral retina detachments last sept. Since my lens was still kind of soft i also had to have. Yag treatment. I have a single focus distance lens and need low 1.25 power cheaters for reading. I was always near sighted so distance sight wo external corrective lenses is kind of strange. Dont worry about being awake for the op. Either it is short. Memail me for more info. I just had addtl surgery for another detachment 10 days ago and typing this on a phone takes.time. Get a distance lens at least.
So mine was similar to FoLA just a different order and i think we share an iol.
Hey i can see after all this craziness you will be fineposted by stuartmm at 2:05 PM on July 19, 2010

Also, while I have a single-focus IOL, I didn't get bifocals until seven years later, and they're pretty weaksauce bifocals.

And yeah, what Stuart said; MeMail me if you want even more detail. I have very little filter when it comes to discussing my heinous eye issues. ;)posted by fairytale of los angeles at 2:17 PM on July 19, 2010

Mrs. Geezer had surgery in one eye about a year ago and expects to have the other eye done in about another year. She opted for the multi-focal lens and is very pleased with the results. She has what is effectively zero correction in the surgical eye and wears glasses only to accommodate the needs of the uncorrected eye. She had no complications and was able to get around normally the day after surgery. You will need someone to be with you on the day of surgery,as the anesthetic can make you a little goofy. From what I can see of the experience, you will most likely be pleased with the results and can benefit from the multi-focal lens notwithstanding the slight increase in cost.

If I need cataract surgery that is the way I will go.posted by Old Geezer at 4:59 PM on July 19, 2010

OOPS! Substitute "Adaptive-Focus" for multi-focus above. She has the new-fangled ones and really likes being able to go without her glasses sometimes without compromising vision at all.posted by Old Geezer at 5:02 PM on July 19, 2010

I asked this question for a friend last year. He's now nearly a year post-surgery and is very happy with his choice.posted by catlet at 6:49 PM on July 19, 2010

Thanks, catlet! (And everyone else who's chimed in so far, of course.)posted by spaceman_spiff at 8:22 PM on July 19, 2010

Thanks for the info and pointers, folks. I am looking into getting this done myself Real Soon Now (I'm currently scheduled for next week). But after reading MeFi and medhelp.org, I realize that my surgeon's office hasn't given me enough info to make me confident. I should have suspected more when I found out that the party cougars trolling the halls were the sales "counselors." At first I thought they were fellow patients, but after seeing the same one flounce by my exam room several times, I egan to wonder what their role could be.posted by markhu at 10:30 PM on December 14, 2010

Since my previous post, I got a 2nd and 3rd opinion and ended up going with the 3rd surgeon.
One major factor was that both he and the out-patient surgical center he operates from are "in-network" with my insurance company (this factor saved me thousands of dollars). Also, he was much more up-front about different treatment/outcome packages available and the pros and cons of the different technologies and considered it a point of pride that he did not represent any manufacturer, so was therefore beholden to none. Also, he took a digital picture of my cataracts and showed them to me. Then he dictated his notes into a recorder and I found listening to that quite informative even though most of it went over my head. A few weeks later, I had the Tecnis® ZCB00 1-Piece Acrylic IOL installed (aspheric single-focus), and am so far very happy with it. I returned to work the day after surgery and tested 20/20. Things are looking very bright and I hope to have the second eye done soon also.posted by markhu at 2:47 PM on March 4, 2011

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